What is ketoconazole?

• Ketoconazole is an antifungal medication. It is like an antibiotic but is used to treat fungal infections.
• Ketoconazole is used to treat yeast infections of the mouth, throat, and esophagus; fungal infections throughout the whole body; and serious fungal infections of the skin and nails.
• Ketoconazole may also be used for purposes other than those listed in this medication guide.

What should I discuss with my doctor before taking ketoconazole?

• Do not take ketoconazole if you are taking any of the following drugs:
  • astemizole (Hismanal),
  • cisapride (Propulsid), or
  • triazolam (Halcion) or midazolam (Versed).
• Dangerous or life-threatening events may occur if ketoconazole is taken with any of the medicines listed above.
• Before taking ketoconazole, tell your doctor if you have
  • liver disease; or
  • achlorhydria (decreased stomach acid production) or if you take antacids, stomach acid reducers, or stomach ulcer medicines.
• You may not be able to take ketoconazole, or you may require a dosage adjustment, special monitoring, or special directions for use during your treatment.
• Ketoconazole is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment.
• Ketoconazole passes into breast milk and may be harmful to a nursing baby. For this reason, ketoconazole should not be taken by nursing mothers. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take ketoconazole?

• Take ketoconazole exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.
• Take each dose with a full glass of water.
• Ketoconazole is usually taken once a day. Follow your doctor's instructions.
• If you have a condition that decreases the amount of acid produced by the stomach, you may require a special mixture of this medication. Drink this solution through a straw far back in the mouth away from the teeth and follow each dose with a swish and swallow of water to prevent damage to the teeth.
• It is important to take ketoconazole regularly to get the most benefit.
• Your doctor may want you to have blood tests or other medical evaluations during treatment with ketoconazole to monitor progress and side effects.
• Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?

• Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose as directed. Do not take a double dose of this medication unless otherwise directed by your doctor.

What happens if I overdose?

• Seek emergency medical attention if an overdose is suspected.
• Symptoms of a ketoconazole overdose are not well known but might include dizziness, ringing in the ears, headache, nausea, vomiting, diarrhea, and abdominal pain.

What should I avoid while taking ketoconazole?

• Alcohol should be used with moderation while taking ketoconazole. Alcohol and ketoconazole can both affect the liver. Rarely, flushing, nausea, vomiting, headache, swelling, and rashes have occurred when alcohol has been used during ketoconazole therapy.
• Use caution when driving or performing other hazardous activities. Ketoconazole may cause dizziness. If you experience dizziness, avoid these activities.

What are the possible side effects of ketoconazole?

• If you experience any of the following serious side effects, stop taking ketoconazole and seek emergency medical attention or contact your doctor immediately:
  • an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); or
  • liver damage (pale stools, yellowish skin or eyes, abdominal pain, unusual fatigue, or dark urine).
• Other, less serious side effects may be more likely to occur. If you experience any of the following side effects, continue to take ketoconazole and talk to your doctor:
  • nausea, vomiting, or abdominal pain;
  • diarrhea;
  • headache;
  • dizziness;
  • fatigue; or
  • itching.
• Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What drug(s) may interact with ketoconazole?

• alcohol
• antacids
• astemizole
• bosentan
• cisapride
• cyclosporine
• didanosine (ddI)
• dofetilide
• doxercalciferol
• ergotamine, dihydroergotamine or methysergide
• hormones such as prednisone or cortisone
• isoniazid
• certain medicines for anxiety or difficulty sleeping
• medicines for lowering cholesterol (such as atorvastatin, lovastatin, simvastatin)
• medicines for movement abnormalities as in Parkinson's disease, or for gastrointestinal problems
• medicines for stomach ulcers and other stomach problems
• other medicines for fungal or yeast infections
• paricalcitol
• pimozide
• pioglitazone
• quinidine
• phenytoin
• rifampin
• terfenadine
• tolbutamide
• warfarin

What is the shelf life of the pills?

• The expiry date is mentioned on each blister. It is different for different batches. The shelf life is 2 years from the date of manufacture and would differ from batch to batch depending on when they were manufactured.

Other Useful Information:

Radiation: 1. Rays of energy. Gamma rays and X-rays are two of the types of energy waves often used in medicine. 2. The use of energy waves to diagnose or treat disease.

Replantation: 1. Literally, the act of planting again. 2. In surgery, the restoration of any part of the body to its original site. Also known as reimplantation.

The Chinese surgeon Zhong Wei Chen (1929-2004) was the "father of replantation." Dr. Chen was the first to reattach a severed hand with success which he did in 1963. Dr. Chen also developed many microsurgical procedures including techniques for preserving severed extremities, reattaching amputated fingers and thumbs, reconstructing muscles and repairing nerves and blood vessels.

Rheumatism: Rheumatism is an older term, used to describe any of a number of painful conditions of muscles, tendons, joints, and bones.

Rheumatism conditions have been classified as either localized, regional, or generalized. Localized rheumatism conditions include bursitis and tendinitis. Regional rheumatism conditions include chest wall pain, temporomandibular joint pain, and myofascial pain syndromes. Generalized rheumatism conditions include fibromyalgia.

Another category of rheumatism is psychogenic rheumatism. With this term it is understood that the patient is reporting inconsistent pains of muscles and joints that do not correspond to true anatomy and physiology. The patient is felt to have underlying psychological causes for the symptoms.

Rheumatology: A subspecialty of internal medicine that involves the non-surgical evaluation and treatment of the rheumatic diseases and conditions. Rheumatic diseases and conditions are characterized by symptoms involving the musculoskeletal system. Many of the rheumatic diseases and conditions feature immune system abnormalities. Therefore, rheumatology also involves the study of the immune system. Classical rheumatology training includes 4 years of medical school, 1 year of internship in internal medicine, 2 years of internal medicine residency, and 2 years of rheumatology fellowship. There is a subspecialty board for rheumatology certification. The American College of Rheumatology is the official organization acting on behalf of the field of rheumatology in the United States.

T cell: A type of white blood cell that is of key importance to the immune system and is at the core of adaptive immunity, the system that tailors the body's immune response to specific pathogens. The T cells are like soldiers who search out and destroy the targeted invaders.

Immature T cells (termed T-stem cells) migrate to the thymus gland in the neck, where they mature and differentiate into various types of mature T cells and become active in the immune system in response to a hormone called thymosin and other factors. T-cells that are potentially activated against the body's own tissues are normally killed or changed ("down-regulated") during this maturational process.

There are several different types of mature T cells. Not all of their functions are known. T cells can produce substances called cytokines such as the interleukins which further stimulate the immune response. T-cell activation is measured as a way to assess the health of patients with HIV/AIDS and less frequently in other disorders.

T cell are also known as T lymphocytes. The "T" stands for "thymus" -- the organ in which these cells mature. As opposed to B cells which mature in the bone marrow.

Teleology: The study of the ultimate purpose of the design of something in nature.

For example, "what is the true purpose of the nose?" is a teleological question and, to say that all evolutionary changes occur for a definite purpose is a teleological explanation of evolution.

"Teleology" comes from ancient Greek roots but it (and teleological) did not enter English until the 18th century. It is a compound of the Greek "tele-, telos," meaning "end or purpose" + the ending "logos" meaning "the science or study of" = the study of the ends or purposes.

Testosterone: A "male hormone" -- a sex hormone produced by the testes that encourages the development of male sexual characteristics, stimulates the activity of the male secondary sex characteristics, and prevents changes in them following castration. Chemically, testosterone is 17-beta-hydroxy-4-androstene-3-one.

Testosterone is the most potent of the naturally occurring androgens. The androgens cause the development of male sex characteristics, such as a deep voice and a beard; they also strengthen muscle tone and bone mass.

High levels of testosterone appear to promote good health in men, for example, lowering the risks of high blood pressure and heart attack. High testosterone levels also correlate with risky behavior, however, including increased aggressiveness and smoking, which may cancel out these health benefits.

Testosterone may be given to treat medical conditions, including female (but not male) breast cancer, hypogonadism (low gonadal function) in the male, cryptorchism (nondescent of the testis into the scrotum), and menorrhagia (irregular periods).